Reversible brain atrophy in anti-NMDA receptor encephalitis: a long-term observational study

J Neurol. 2010 Oct;257(10):1686-91. doi: 10.1007/s00415-010-5604-6. Epub 2010 Jun 2.


The long-term neuroimaging correlates of clinical recovery have not been described in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. The aim of the study is to evaluate the long-term outcome of brain atrophy in anti-NMDAR encephalitis. Patients were two women (ages 17 and 33 years) with severe anti-NMDAR encephalitis resulting in decreased level of consciousness, autonomic instability, hypoventilation, and dyskinesias requiring continuous infusion of anesthetic agents for 6-7 months. Brain MRI and cerebral blood flow SPECT obtained at the time of maximal neurological disability were compared with similar studies obtained 5-7 years later. Both patients were hospitalized for 9-14 months and developed frontotemporal atrophy and hypoperfusion 7-12 months after symptom presentation. In both patients, cognitive functions gradually improved over the next 4-5 years. Comparative neuroimaging studies obtained 5-7 years after symptom presentation showed dramatic improvement of the atrophy and frontotemporal hypoperfusion. The severe and protracted deficits and the frontotemporal atrophy that occur in some patients with anti-NMDAR encephalitis are potentially reversible. This suggests that a functional rather than a structural neuronal damage underlies the pathogenesis of this disorder.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Antibodies / blood
  • Antibodies / cerebrospinal fluid
  • Atrophy / etiology
  • Brain / diagnostic imaging
  • Brain / pathology*
  • Brain Mapping
  • Encephalitis* / complications
  • Encephalitis* / diagnosis
  • Encephalitis* / immunology
  • Female
  • Humans
  • Longitudinal Studies
  • Magnetic Resonance Imaging / methods
  • Observation
  • Receptors, N-Methyl-D-Aspartate / immunology*
  • Tomography, Emission-Computed, Single-Photon / methods


  • Antibodies
  • Receptors, N-Methyl-D-Aspartate